Establishing minimally invasive cardiac surgery in a low-volume mitral surgery centre
| Autor: | Andrew Knowles, Palaniqumar Saravanan, Bilal H. Kirmani, Joseph Zacharias |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Hospitals Low-Volume Heart Diseases Operative Time education Heart Valve Diseases 030230 surgery Young Adult 03 medical and health sciences 0302 clinical medicine Mitral valve Atrial Fibrillation Minimally invasive cardiac surgery Humans Minimally Invasive Surgical Procedures Medicine Hospital Mortality Cardiac Surgical Procedures Aged Retrospective Studies Aged 80 and over Cardiopulmonary Bypass Interventional cardiology business.industry Heart Septal Defects General Medicine Middle Aged Sternotomy Surgery Low volume medicine.anatomical_structure Thoracotomy Female business Learning Curve |
| Zdroj: | The Annals of The Royal College of Surgeons of England. 103:444-451 |
| ISSN: | 1478-7083 0035-8843 |
| DOI: | 10.1308/rcsann.2020.7092 |
| Popis: | Introduction Despite early enthusiasm, minimally invasive cardiac surgery has had a low uptake compared with novel techniques in interventional cardiology. Steep learning curves from high-volume centres have deterred smaller units from engaging, even though low-volume centres undertake a large proportion of surgical interventions worldwide. We sought to identify the safety and experience of learning minimally invasive cardiac surgery after undertaking a structured fellowship at Blackpool Victoria Hospital, a low-volume centre. Materials and methods A retrospective analysis of outcomes for all consecutive minimally invasive cardiac surgery procedures performed via a right mini-thoracotomy at our institution between 2007 and 2017 was undertaken. Clinical outcomes included death, conversion to sternotomy, stroke, renal failure and other organ support. Cardiopulmonary bypass, aortic cross-clamp times and learning cumulative sum sequential probability method curves were also assessed to determine how safely the procedure was adopted. Results A total of 316 patients were operated on for mitral, tricuspid, atrial fibrillation, septal defects or other conditions. The mean logistic European System for Cardiac Operative Risk Evaluation score was 7.0 (± 8.5). Conversion to sternotomy occurred in 12 patients (3.8%) and in-hospital mortality was 7 (2.2%). None of the converted patients died. The learning curves showed an accelerated process of adoption, similar to reference figures from a high-volume German centre. Discussion It is possible for low-volume cardiac surgical centres to undertake minimally invasive surgical programmes with good outcomes and short learning curves. Despite technical complexities, with a team approach, the learning curve can be navigated safely. |
| Databáze: | OpenAIRE |
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